High-intensity inspiratory muscle training in COPD.

1. High-intensity inspiratory muscle training in COPD. Abstract Hill K, Jenkins SC, Philippe DL, Cecins N, Shepherd KL, Green DJ, Hillman DR, Eastwood PR. European Respiratory Journal. 2006; 27: 1119-1128 Background/Introduction Study design Prospective, double-blind, random-control design 2 week screening and “familiarization” phase for baseline Assessments performed 4 times Groups assigned via a random number sequence Measurements were repeated at the end of the 8 week session Training protocol Subjects trained three days per week for 8 weeks H-IMT intensity was set at the maximum load tolerated S-IMT intensity was 10% of the baseline peak inspiratory pressure Subjects chose their own breathing pattern Measurement Resting lung function Inspiratory muscle strength Inspiratory muscle endurance • Measured as the maximum pressure sustained for 30+ seconds Whole-body exercise capacity • Cycle ergometer • 6 minute walk test Health-related QOL by the CRDQ Methods Baseline compared between groups with unpaired t-test or Chi-square Pre- and post-training between H-IMT and S-IMT analyzed with two-way repeated measures ANOVA Pre- and post-training differences within H-IMT and S-IMT analyzed with paired t-tests. Inspiratory capacity unchanged over 8-week training in both groups Greater gains in H-IMT training No between groups differences found for exercise capacity with cardiopulmonary measures Results continued Conclusion H-IMF has significant effect on increasing IMT and decreasing dyspnea and fatigue with ADLs Patients with COPD are able to tolerate higher intensities and loads with the interval based training protocol. No evidence for use of H-IMF in whole body exercise and increasing exercise capacity. Article 2 Weiner P, Weiner M. Inspiratory muscle training may increase peak inspiratory flow in chronic obstructive pulmonary disease. Respiration. 2006; 73: 151-156 Examined effectiveness of IMT to help patients with COPD increase peak inspiratory flow rates and ease the work to use dry power inhalers. RCT, double-blind study found a statistically significant, positive correlation between inspiratory muscle strength and peak inspiratory flow rates. Patients with COPD should be on a IMT program to efficiently use commonly prescribed inhalers. Summary Shoemaker MJ, Donke S, LaPoe S. Inspiratory muscle training in patients with chronic obstructive pulmonary disease: the state of the evidence. Cardiopulmonary Physical Therapy Journal. 2009; 5: 5-15 Assessed literature for the clinical benefit for Examined training intensity relationships between changes in inspiratory muscle function and clinical outcome measures 15 articles reviewed IMT did lead to increases in PImax, but only 3 out of the 15 studies reported using IMT to successfully decrease feelings of dyspnea. Purpose Evidence supports improvement in inspiratory muscle function post-IMT-training Little research on quality of life and exercise capacity changes in patients with Most of the current research involve studies with sub-maximal training programs Interval training programs seem to achieve higher training load with less dyspnea. Authors of this study examined higher intensity training, as well as looking at changes in capacity and quality of life. H-IMT was well tolerated with interval-based approach and rest periods Allowed for gains of up to 56% in intensity from baseline Gains noted to be greater than or comparable to previous research Interval training programs had significant reports of improvement in inspiratory muscle strength. H-IMT had little effect on whole body endurance • not significantly different from S-IMT in QOL scores H-IMT did show significance in improving symptoms of dyspnea and fatigue in ADLs. IMT does produce significant differences in feelings of fatigue and dyspnea, and strength gains of inspiratory muscle strength. The articles support a general IMT program Primary article indicates benefit of increasing IMT intensity for greater gains High intensity achieves gains in fatigue and dyspnea similar to basic IMT programs, but in less time and with greater loads All articles looked at IMT with COPD and cannot be generalized to other patient populations H-IMF could be useful for dyspnea, fatigue with their ADLs, and endurance Faster gains in IMF in shorter periods of time Able to achieve high training loads Training protocol seems to be very demanding with little benefit to function and quality of life Data does not generalize to other populations Subjects Inclusion criteria: COPD, smoker >10 pack-years, FEV1 of 15-70% Exclusion criteria: comorbidities that interfere with exercise, previous lung surgery, long-term oxygen therapy, and weaning doses of oral corticosteroids. 55 subjects: 34 males, 21 females 17 excluded at screening, 3 withdrew 35 subjects were randomized to H-IMT or S-IMT Poster presented by: Dalie Camic, Doctor of Physical Therapy Student Bellarmine University The aim of the present study was to investigate the effects of an interval-based high-intensity inspiratory muscle training (H-IMT) program on inspiratory muscle function, exercise capacity, dyspnea and health-related quality of life (QOL) in subjects with chronic obstructive pulmonary disease (COPD). A double-blind randomized controlled trial was performed. Sixteen subjects (11 males, mean forced expiratory in one second (FEV1) 37.4±12.5%) underwent H-IMT performed at the highest tolerable inspiratory threshold load (increasing to 101% of baseline maximum inspiratory pressure). Seventeen subjects (11 males, mean FEV1 36.5±11.5%) underwent sham inspiratory muscle training (S-IMT) at 10% of the maximum inspiratory pressure. Training took place three times a week for 8 weeks and was fully supervised. Pre- and post-training measurements of lung function, maximum inspiratory pressure, maximum threshold pressure, exercise capacity, dyspnea and QOL (Chronic Respiratory Disease Questionnaire; CRDQ) were obtained. H-IMT increased maximum inspiratory pressure by 29%, maximum threshold pressure by 56%, 6-minute walk distance by 27 m, and improved dyspnea and fatigue by 1.4 and 0.9 points per item, respectively on the CRDQ. These changes were significantly greater than any seen following S-IMT. In conclusion, H-IMT improves inspiratory muscle function in subjects with moderate-to-severe COPD, yielding meaningful reductions in dyspnea and fatigue. The purpose of this study was to determine the effect of high intensity inspiratory muscle training (H-IMT) on inspiratory muscle function, exercise capacity, dyspnea, and quality of life in patients with chronic obstructive pulmonary disorder (COPD). Materials Results Article 1 Clinical significance Discussion http://news.thomasnet.com/fullstory/Universal-I-O-Transmitters-accept-up-to-3-inputs-572918 http://www.heartratemonitor.co.uk/powerbreathe_fitness_plus.html